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NAME <br />ADDRESS <br />Ilnrlttde FariGtr :Yamr/l~tatiun if INffirent! <br />FACILITY <br />LOCATION 14ar~ <br />r~. <br />.G <br />NATIONAL POLLUTANT DISCHARGE ELIMINATION SYSTEM ((NPDES) <br />DISCHARGE MONITORING REPORT (DMR) <br />PERMIT NUMBER DISCHARGE NUMBER <br />MONITORING PERIOD <br />YEAR MO DAY YEAR MO DAY <br />FROM TO <br />Form Approved. <br />OMB No. 2040.0004 <br />Mir <br />al <br />r` - <br />M Ir1 <br />NOTE: Read Instructions before completing this form. <br />PARAMETER QUANTITY OR LOADING QUALITY OR CONCENTRATION NQ• FREQUENCY <br />OF SAMPLE <br /> EX TYPE <br /> ANALYSIS <br /> AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br /> REQUIREMENT <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br /> REQUIREMENT <br /> <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br /> REQUIREMENT <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT - >:,.L~..,~ ;.. <br /> REQUIREMENT <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT `-~~;~s <br /> REQUIREMENT <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br /> REQUIREMENT ~ <br /> . . <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br /> REQUIREMENT <br />NAME/TITLE PRINCIPAL EXECUTIVE OFFICER I crrtifs under lx•nah+ ..f law that this d.wvmem and ull attnrhmcnt+wem <br />pmpamd under m~ dirn~tiwt wr aspen ision in asYOrdaner with u ccatem de+iAtted TELEPHONE DATE <br /> t.. m-sum shat yualificd prrwmncl properh ¢uther and esalualc the information <br /> whmitted. Rand un m+ inyuin of the prr.im or prrsott+ who manage llx system, ' <br /> or thmc perwms dinvtls msgmslhle fnr Katherit* the information. the informa8an <br /> e uud M4ief <br />true <br />aerurutr <br />and rum <br />kte <br />itt <br />ro th <br />ter+I of <br />k <br />~wl <br />d <br />h <br />d i <br /> , <br />, <br />. <br />p <br />. <br />e <br />+, <br />e <br />my <br />m <br />y <br />k <br />su <br />m SIGNATURE OF PRINCIPAL EXECUTIVE <br /> <br />TYPED OR PRINTED I am aware that them are signirteant prnahi.~ for u~bmiltinR false information. <br />irtdudink the IeKSihility of tint and impri.onnu w for AnowinR +iulations. OFFICER OR AUTHORIZED AGENT AREA <br />NUMBER <br />YEAR <br />MQ <br />DAY <br />COMMENTS AND EXPLANATION OF ANY VIOLATIONS (Reference all attachments here) <br /> <br />EPA Form 3320-t (Rev. 3/99) Previous edeions may be used. ~ _ ~ This is a 4-part form. <br />